Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01064992A | IN |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01064992A | IN |
NPI | 1114127768 |
---|---|
Provider Name | Dr. Lisa Marie Richmond |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46260-2479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 10/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000570502 | ANTHEM (01) | IN |